Everything You Need to Know About Accutane and Acne

Charles suffered from severe acne for 10 years. He tried almost every acne product on the market before finally going on Accutane in 2011.

What Is Accutane?

Accutane, which is known scientifically as 13-cis-retinoic acid, is a very potent drug used for the treatment of severe acne. It is one of the most restricted drugs on the FDA list and for good reason.

This drug was initially developed to be used as a chemotherapy medication for the treatment of brain cancer, pancreatic cancer and more. The drug is still undergoing research for use in head and neck cancer chemoprevention.

In children with high-risk neuroblastoma, treatment with 13-cis-retinoic acid reduces the risk of cancer coming back after high-dose chemotherapy and stem cell transplant.

How Accutane Began to Be Used in Acne Treatment

Medical professionals discovered as far back as the 1930s that high dosages of vitamin A could cause the sebaceous glands in the skin to produce less sebum. Sebum is an oily substance which though good for the skin can cause acne under certain conditions.

Accutane (isotretinoin) was initially investigated as a treatment for skin cancer at Roche Laboratories in Switzerland by Werner Bollag in the 1960s but was found to be ineffective for cancer treatment. Being a derivative of vitamin A, isotretinoin was also found to help drastically reduce sebum production. Though it looked promising as a potential cure for acne, Roche Laboratories also discovered that the drug could cause birth defects and so abandoned it.

In 1975, two scientists, Gary Peck and Frank Yoder, accidentally discovered that isotretinoin cleared up acne while studying it as a treatment for lamellar ichthyosis, a severe skin disorder. Subjects who had been covered with acne returned to the office with clear skin. They went ahead to publish their findings.

Roche resumed work on the drug and isotretinoin became Accutane. In clinical trials, subjects were carefully screened to avoid including women who were or might become pregnant. Roche's New Drug Application for isotretinoin for the treatment of acne included data showing that the drug caused birth defects in rabbits. The FDA approved the application in 1982.

Why Accutane Was Taken Off the Market

In the summer of 2009, Accutane manufacturer, Roche Pharmaceuticals, stopped manufacturing the drug. Roche announced in a news release they pulled Accutane from the market because of “business reasons“.

One of the reasons was declining sales. Representatives for Roche said the acne treatment had hit the end of its life cycle because of the end of its patent and the addition of several generic Accutane drugs to the market.

Another huge reason was personal injury lawsuits from patients who suffered some of the more extreme and terrible side effects of Accutane. In 2010, an Alabama man who filed a product liability lawsuit against Roche Holding AG was awarded over $25 million after he developed inflammatory bowel disease (IBD) and had to undergo five surgeries – one to remove his colon.

It is very important you weigh the potential benefits against the potential risks before taking this drug. This is because the list of side effects from this drug is quite scary. In cases where an individual has very severe acne which affects his or her quality of life and his or her ability to live a normal life in society, then there is every reason to consider Accutane.

How Acne Forms?

Acne is a skin disease that normally affects people during their teen years. This is when most people have reached their adolescent stage and hence their bodies have started producing sex hormones. These hormones send signals to the sebaceous glands to produce more sebum.

In most people, the sebaceous glands produce the right amount of sebum which does not clog any pores. However, in some cases, there is an excessive production of sebum which results in it clogging the pores. Bacteria can get trapped in the pores as well and the immune system reacts to this by producing white blood cells to attack the bacteria in the clogged pores. This results in the inflammation of the skin and that is what we call acne.

Severity of Acne

Acne can differ in severity and this is mainly due to the amount of sebum produced and how deep it is trapped under the skin. Acne can be classified as mild, moderate or severe.

Mild acne: This normally manifests itself in the form of non-inflammatory lesions (whiteheads and blackheads). The lesions are referred to as non-inflammatory because they are just clogged pores that haven't been infected with bacteria. This type of acne is usually not painful and causes very little scarring.

Moderate acne: This often has a combination of inflammatory and non-inflammatory lesions and affects quite a significant portion of the skin's surface. Inflammatory lesions consist of clogged pores that have become infected with bacteria.

Severe acne: This usually manifests itself in the form of cysts and nodules. Cysts and nodules are severe forms of inflammatory acne and are formed deep underneath the skin's surface. This type of acne causes extensive scarring and can really affect the psychological well-being of the individual it afflicts.

You might want to avoid taking Accutane if you have mild to moderate acne since the benefits are not worth the risks. If you suffer from moderately severe to severe acne, you can opt for Accutane. However, the final decision whether to prescribe you Accutane or not lies with your doctor and would assess if your acne is severe enough to warrant a prescription.

How Acne Forms Under Skin

How Is Acne Treated?

There are various ways of treating acne and it usually depends on the severity of your acne. Below are the most common:

Over-the-Counter Acne Drugs

Oral Antibiotics

Birth Control Pills

Diet

Accutane

Source

Over-the-Counter Acne Drugs

The first step in acne treatment is usually through over the counter medications. These drugs are mostly topical medications where you apply them directly to the area affected by acne. The active ingredients in most over the counter medications are benzoyl peroxide, tretinoin, sulfur, salicylic acid, antibiotics and alpha hydroxy acids.

These drugs serve different purposes.

They help to reduce inflammation.

They kill bacteria and also make the skin less hospitable for bacteria.

Over-the-counter acne products help decrease sebum on the surface of the skin.

They assist in the quick renewal of the skin and help remove dead skin cells so that sebum does not have enough time to clog the pores.

However, it must be noted that if you are suffering from severe cystic or nodular acne, topical acne medications would not be of much help since these drugs do not attack bacteria deep within the skin. Topical medications cannot penetrate deep into the skin where bacteria are located. They are therefore effective for mild to moderate acne. The disadvantage of these medications is that you have to continue using them until your acne finally goes away on its own which can be quite expensive.

Oral Antibiotics

Oral antibiotics include drugs like tetracycline and erythromycin. These drugs attack bacteria deep within the skin that cause inflammation. It is effective for cystic and nodular acne and can help relieve inflammation for some time.

However, antibiotics cannot be taken regularly for a long period of time since the bacteria that cause acne (p. acnes) can become resistant and may not respond to treatment. Also, long-term use of antibiotics can make you prone to certain infections in the future.

Birth Control Pills

Birth control pills can help reduce acne in women since they help reduce androgen production which in turn reduces acne formation. However, staying on birth control pills for a long time also has its side effects. Some women have reported an increase in weight, headaches, nausea and vomiting after being on birth control pills.

Diet

There has been a strong connection between acne and diet. Certain types of food have been found to alter hormone levels which in turn exacerbate acne. Some people have reported an increase in their acne after eating foods that are rich in cholesterol such as shellfish and seafood (shrimps).

Others have also reported an increase in their acne from excessive consumption of dairy and sugar. People who are intolerant to gluten and wheat have reported an increase in acne after consuming foods that contain gluten.

Acne may be a way of your body telling you that it is allergic to some foods that you are consuming at the moment. You can therefore gradually eliminate certain foods from your diet and monitor the progress of your skin over time. You can also keep a journal and record the food you eat every day and monitor its effect on your skin.

Certain diets have also been found to help relieve acne. One of the simplest ways to improve your skin is to drink a lot of water. Water helps to flush out excess toxins from your skin and body which might be causing your acne.

You can also introduce more vitamin A and vitamin C rich food sources into your diets. Vitamin A promotes normal turnover of skin cells which helps prevent acne and Vitamin C helps protect your body from toxins. Certain individuals have seen a tremendous improvement in their skin after switching to a vegan diet.

Starting Accutane

Accutane is often considered for the treatment of severe cases of acne that do not respond to other acne treatments. It is first advisable to talk with your doctor so that he or she can outline some of the potential effects of taking this drug.

Women are expected to do a mandatory pregnancy test before taking this drug as Accutane has been linked to the abnormal development of fetuses in the wombs of pregnant women. Your doctor may also require you to do a series of liver tests to make sure you don't have any underlying liver conditions as Accutane has been linked to liver disorders in some patients.

People on Accutane are normally obliged to take blood tests every month to make sure their liver enzymes and triglyceride levels are within normal limits.

Cumulative Accutane Dose

Once the drug is prescribed, your daily dose is dependent on your weight and the severity of your acne. If you weigh 60 kg you may be required to take 60 mg a day. Also, if you weigh 80 kg you may be required to take 80 mg a day. The drug is normally taken for 6 months. However, the duration may vary.

The most important thing is to reach the maximum cumulative dose which is 120mg/kg. This prevents your acne from coming back and hence avoids the need to take a second course. It is advisable to take Accutane with a high-fat meal since this ensures optimal absorption.

Common Side Effects of Accutane

The most common side effects of taking the drug are chapped lips and dry skin. It is advisable to have some form of moisturizer always with you to keep your skin and lips moist. You can also experience peeling of the skin from this drug and hence a good moisturizer is always recommended. Joint pain is also another common side effect of Accutane and is therefore advisable to limit your physical activities during your treatment.

It is very important to note that Accutane can sometimes cause your acne to become severe for the first few months before finally clearing your skin. This is because it causes your skin to purge out all the acne that has been trapped under your skin. Hence, you shouldn't be discouraged when your skin is not improving for the first few months.

Some people have reported mood swings whilst they were on Accutane. It is very important for the family members of Accutane users to monitor them and report any unusual behaviours so as to get appropriate help since Accutane has been linked to suicide in some individuals.

Success Rate of Accutane

Accutane can really transform the lives of some individuals and give them a chance to start their life afresh. The quality of life of such individuals is greatly improved and they go ahead to live their life to the fullest. However, the emotional scars from having acne usually take a long time to heal and they will forever remember the horrible experiences they encountered as a result of being afflicted with acne. They come to view the world in a new light and learn to treat everyone with respect no matter their condition.

Accutane has a success rate of over 80% which is very good. This means that for 80% of individuals who take Accutane, they can live their life free of acne for a very long time. Of course, there would be the occasional acne here and there but it would be nowhere near what it was before they took Accutane. For the remaining 20%, they might have to take a second course of Accutane to rid their skin of acne forever.

Sources

Isotretinoin. (n.d.). In Wikipedia. Retrieved May 5, 2016, from https://en.wikipedia.org/wiki/Isotretinoin

Accutane Side Effects. History of Accutane. Available from: http://accutanesideeffect.weebly.com/the-history-of-accutane.html [Accessed 5 May 2016]

MedicalNewsToday (2017). What you need to know about acne. Available from: https://www.medicalnewstoday.com/articles/107146.php [Accessed 10 May 2018]

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